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NBME 22 Answers

nbme22/Block 4/Question#18 (35.1 difficulty score)
A 10-year-old girl has a slightly painful ...

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 +19  upvote downvote
submitted by seagull(1107),
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hTe surtoah ntwe out fo rethi awy ot ifdn wthe rwsot thoop fo a louganmra ythe l.ocud hTe ertwh on a smte thta gtesguss tath it dolwu eb anluntragio ius.te But elttli did we ...wkno

amorah  I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +16  
sbryant6  Got this right because the exact same question is in Uworld. +  
dubywow  Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1  
groovygrinch  Anytime they go out of their way to mention sutures, my mind goes right to granulomas +  
beto  there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +3  

 +5  upvote downvote
submitted by kard(33),
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hgiMt eb ihts a,yw tecrorc em elpeas if my poapahrc is .iteoSakns m ni the teSm ew evah a alufPin dnolue, ue(D to 1wks0ee oga ertu )sSSou mi nkhngiti on uerutS n,ugraalmo ttha smofr a seinlo nfP(luia N oue)drdanroul eth absobnrobnale- etusur itlmreaa.

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sI the gyre peosdusp to be a rsu?etu fI not wyh wdulo isht ont be nouwd iaelhng rrteheoef orlaguaintn ss?iuet

asapdoc  If you look at the picture you can see the epithelioid and giant cells. I only picked granuloma because I remember seeing a similar picture in Uworld. +5  
dentist  granulation tissue is a part of the normal wound healing process, and happens within the first week. +  
castlblack  I agree I looked at that grey blob and thought foreign body --> granuloma +  

A suture granuloma essentially is a foreign body reaction to suture remaining in the tissue after surgery. It is generally a tender, erythematous nodule that occurs several days to weeks after surgery. A suture granuloma is treated with intralesional steroids or excision.